Dear Administrator Letter
- Letter is also available in Portable Document Format (PDF)
August 23, 2022
Dear Administrator:
This letter provides you with information regarding your Residential Health Care Facility (RHCF) Medicaid reimbursement rates effective July 1, 2017 through April 1, 2022 as follows.
| Rate Action | Rate Period | MMIS Cycle # and Check Release Date | |
|---|---|---|---|
| Release 5% Case Mix Index Cap | July 1, 2017 through January 1, 2021 | #2349 | 9/14/22 |
| Recalculate the 1.5% ATB Investment Annually | January 1, 2019 through July 1, 2021 | #2349 | 9/14/22 |
| January 1, 2022 | #2343 | 8/3/22 | |
| April 1, 2022 | #2350 | 9/21/22 | |
Release 5% Case Mix Index Cap: Prior to June 2, 2021, State regulations stated case mix changes may be limited to a 5 percent change (both increases and decreases). Effective June 2, 2021, the regulation was amended to eliminate the 5 percent case mix cap language. As a result, the Department is releasing funds held and recouping funds owed pursuant to the 5% case mix cap, for the rate periods July 1, 2017 through January 1, 2021.
Recalculate the 1.5% ATB Investment Annually: The 1.5% increase was applied to the November 1, 2018 rates and not refreshed each year when initial (i.e. January) rates were released. The1.5% increase for the initial rates in effect for the rate periods January 1, 2019 through January 1, 2022 is now refreshed. Information regarding the release of the January 1, 2022 Initial Capital Rates and the implementation of the 1% ATB Investment effective April 1, 2022 will be provided in a separate letter.
The rates will be available on the Health Commerce System (HCS) application (Healthcare Financial Data Gateway) by Wednesday, August 24th. If you have questions regarding the rates, please send an email to nfrates@health.ny.gov and Conor Petter will respond to your inquiry.
For facilities with a net balance due, recoupment will begin in cycle 2349 at 15% per week, which is the check released on 9/14/22. Interest will be assessed on the unpaid balance after 10 weeks in cycle 2359 at prime plus 2%. Questions regarding Medicaid liabilities, recoupments, the balance due or to establish an alternative payment arrangement please contact the AR Recovery Unit at BIMAMAIL@health.ny.gov .
Please include the name of your facility and MMIS# in the subject line of your email.
Sincerely,
Laura Rosenthal, Bureau Director
Bureau of Nursing Homes and Long-Term Care Rate Setting
Division of Finance and Rate Setting
Office of Health Insurance Program
